Cervical Cancer Screening, Pelvic Examinations, and Contraceptive Use Among Adolescent and Young Adult Females

PURPOSE

The purpose of this study was to characterize the association between pelvic examination and adolescent contraceptive method use in two time periods in the 2006-2010 National Survey of Family Growth (NSFG).

METHODS

Using data from the 2006-2010 NSFG, we used descriptive statistics and multivariable regression models to examine the association between pelvic examination and/or Pap smear and use of effective or highly effective contraceptive methods during two time periods (2006-2008 and 2008-2010). We used the design characteristics of the NSFG to produce population estimates.

RESULTS

More than half (57.3%) of our target population reported that they had a pelvic examination and/or Pap smear in the preceding 12 months. After considering health service use, pregnancy history, and demographic characteristics, receipt of pelvic/Pap remained significantly associated with use of effective or highly effective methods of contraception. Adjusted odds ratio = 1.86; 95% confidence interval (CI), 1.17-2.97. When we examined the relationship between pelvic/Pap and use of effective or highly effective methods within time periods, we found that the odds of effective contraception use were higher among adolescents who had received a Pap/pelvic examination in Period 1 (June 2006-May 2008) but not in Period 2 (June 2008-May 2010). Odds ratio = 3.05; 95% CI, 1.53-6.03 and odds ratio = 1.52; 95% CI, .88-2.62, Periods 1 and 2 respectively.

CONCLUSIONS

This finding provides some reassurance that although indications for pelvic examination and Pap smear among adolescents have decreased, the previously documented association between pelvic examination and effective or highly effective contraception appears to have decreased.

Cytomorphometric and Morphological Analysis in Women with Trichomonas vaginalis Infection: Micronucleus Frequency in Exfoliated Cervical Epithelial Cells

OBJECTIVES

The aim of this study was to explore the cytomorphometric and morphological effects of Trichomonas vaginalis in exfoliated epithelial cells.

STUDY DESIGN

Ninety-six Pap-stained cervical smears were divided into a study group and two control groups as follows: T. vaginalis cases, a first control group with inflammation, and a second control group without inflammation. Micronucleated, binucleated, karyorrhectic, karyolytic, and karyopyknotic cells and cells with perinuclear halos per 1,000 epithelial cells were counted. Nuclear and cellular areas were evaluated in 70 clearly defined cells in each smear using image analysis.

RESULTS

The frequencies of morphological parameters in the T. vaginalis cases were higher than the values of the two control groups, and the difference among groups was found to be significant (p < 0.05). The nuclear and cytoplasmic areas of epithelial cells were diminished in patients with trichomoniasis. The mean nucleus/cytoplasm ratio in T. vaginalis patients was higher than the value in the control groups, and the difference between the study group and control group 1 was significant. However, there was no statistically significant increase between the study group and control group 2.

CONCLUSIONS

T. vaginalis exhibited significant changes in the cellular size and nuclear structure of the cells. The rising frequency of micronuclei, nuclear abnormalities, and changing nucleus/cytoplasm ratio may reflect genotoxic damage in trichomoniasis.

Proflavine Hemisulfate as a Fluorescent Contrast Agent for Point-of-Care Cytology

Proflavine hemisulfate, an acridine-derived fluorescent dye, can be used as a rapid stain for cytologic examination of biological specimens. Proflavine fluorescently stains cell nuclei and cytoplasmic structures, owing to its small amphipathic structure and ability to intercalate DNA. In this manuscript, we demonstrated the use of proflavine as a rapid cytologic dye on a number of specimens, including normal exfoliated oral squamous cells, cultured human oral squamous carcinoma cells, and leukocytes derived from whole blood specimens using a custom-built, portable, LED-illuminated fluorescence microscope. No incubation time was needed after suspending cells in 0.01% (w/v) proflavine diluted in saline. Images of proflavine stained oral cells had clearly visible nuclei as well as granular cytoplasm, while stained leukocytes exhibited bright nuclei, and highlighted the multilobar nature of nuclei in neutrophils. We also demonstrated the utility of quantitative analysis of digital images of proflavine stained cells, which can be used to detect significant morphological differences between different cell types. Proflavine stained oral cells have well-defined nuclei and cell membranes which allowed for quantitative analysis of nuclear to cytoplasmic ratios, as well as image texture analysis to extract quantitative image features.

hr-HPV testing in the management of women with ASC-US+ and in the follow-up of women with cytological abnormalities and negative colposcopy. Recommendations of the Italian group for cervical cancer screening (GISCi)

Compared to spontaneous screening, an organized screening programme is characterized by the presence of protocols and recommendations for all stages including follow-up. Despite the availability of well-functioning screening programmes throughout the country, the follow-up protocol after an abnormal Pap test and negative colposcopy is not clearly defined in Italy, and there is no uniformity of indications. HPV testing for oncogenic human papillomavirus (hr-HPV) has a high negative predictive value (NPV) and high positive predictive value (PPV) for CIN2+ and its employment can reduce follow-up assessments. In order to provide indications about the management of women with ASC-US+ and the follow-up of women with cytological abnormalities and negative colposcopy, a literature analysis was carried out, taking into consideration European and American guidelines and good practice recommendations from the most important scientific associations and regulatory agencies. GISCi (Italian Group for Cervical Screening) drafted recommendations for the management of women with ASC-US, L-SIL, ASC-H, AGC, and H-SIL until their return to the routine screening interval. This protocol can be applied not only in the management of abnormal Pap smears in cytology-based programmes, but also in the management of abnormal Pap test triage after HPV positive test when HPV is the primary screening test. The protocols approved within the screening programmes must have an extensive consensus among all involved professionals, including any that women might meet outside the programme.

Thinprep plus Papanicolaou stain method is more sensitive than cytospin-coupled Wright Giems stain method in cerebrospinal fluid cytology for diagnosis of leptomeningeal metastasis from solid tumors

BACKGROUND

The present study was designed to determine whether the Thinprep plus Papanicolaou stain (Thinprep) method is more sensitive than the Cytospin-coupled Wright-Giemsa (WG) stain (Cytospin) method in diagnosis of leptomeningeal metastasis (LM) from malignant solid tumors in cerebrospinal fluid (CSF). We also explored if the Thinprep method could be used in the differential diagnosis of the type of primary tumor cells based on the morphology of tumor cells in CSF samples.

METHODS

The morphological features of tumor cells in fresh CSF samples were analyzed using both methods. The tumor cell detection rates were compared between the two methods.

RESULTS

Using the Thinprep method, we found that each type of tumor cells in the CSF samples had specific identifiable morphological features linked to their primary cancer origins, such as adenocarcinomas originated from the lungs, breast, and stomach, and lung squamous cell carcinomas, small cell lung cancer, large-cell neuroendocrine lung cancer, hepatocellular carcinoma, and malignant melanoma. In a retrospective study with 88 LM patients, cancer cells were detected in 80 out of the 88 CSF samples. In the comparative study with 45 LM patients, the initial detection rate of the Thinprep method was significantly higher than that of the Cytospin method (73.3% vs. 57.8%, P<0.01). The cell morphology was better preserved and subcellular structures were clearer using the Thinprep method, compared to the Cytospin method.

CONCLUSIONS

The Thinprep method is more sensitive and suitable for LM diagnosis in CSF in patients with malignant solid tumors than the Cytospin method. The Thinprep method may facilitate primary tumor detection and help design early treatment regimens for LM patients with tumors of unknown primary origin.

An improved joint optimization of multiple level set functions for the segmentation of overlapping cervical cells

In this paper, we present an improved algorithm for the segmentation of cytoplasm and nuclei from clumps of overlapping cervical cells. This problem is notoriously difficult because of the degree of overlap among cells, the poor contrast of cell cytoplasm and the presence of mucus, blood, and inflammatory cells. Our methodology addresses these issues by utilizing a joint optimization of multiple level set functions, where each function represents a cell within a clump, that have both unary (intracell) and pairwise (intercell) constraints. The unary constraints are based on contour length, edge strength, and cell shape, while the pairwise constraint is computed based on the area of the overlapping regions. In this way, our methodology enables the analysis of nuclei and cytoplasm from both free-lying and overlapping cells. We provide a systematic evaluation of our methodology using a database of over 900 images generated by synthetically overlapping images of free-lying cervical cells, where the number of cells within a clump is varied from 2 to 10 and the overlap coefficient between pairs of cells from 0.1 to 0.5. This quantitative assessment demonstrates that our methodology can successfully segment clumps of up to 10 cells, provided the overlap between pairs of cells is <;0.2. Moreover, if the clump consists of three or fewer cells, then our methodology can successfully segment individual cells even when the overlap is ~0.5. We also evaluate our approach quantitatively and qualitatively on a set of 16 extended depth of field images, where we are able to segment a total of 645 cells, of which only ~10% are free-lying. Finally, we demonstrate that our method of cell nuclei segmentation is competitive when compared with the current state of the art.

Follow-up of women with inadequate Pap smears: a prospective cohort study

CONTEXT AND OBJECTIVE

Inadequate Pap smears do not provide satisfactory cell samples for evaluation, thus making it more difficult to detect cervical cytological abnormalities. The objective of this study was to determine the cytological and histological follow-up results from women with inadequate smear reports in primary healthcare centers in Santiago, Chile 2010-2011.

DESIGN AND SETTING

Prospective cohort study at primary healthcare clinics in Santiago, Chile.

METHODS

The population was taken from the "Cito-Expert" database of 2010. The data were then organized according to the cytological and histological follow-up results of 2,547 women with inadequate cervical cytological reports over the 12-month period. The samples were assigned to groups based on the cause of inadequacy (smears with endocervical cells alone; insufficient, hemorrhagic, inflammatory or poorly fixed samples; insufficient and hemorrhagic samples; or insufficient and inflammatory specimens). The data were analyzed using the "conditional probability tree diagram" and descriptive statistics.

RESULT

Half of the women (n = 1,285) met the requirements of the Ministry of Health for repeating these inadequate smears, and 1,104 of these women had normal cytological results (85.9%). The detection rate for cervical lesions according to group ranged from 0% (smears with endocervical cells alone or insufficient and hemorrhagic specimens) to 4.1% (poor fixation).

CONCLUSION

The large proportion of normal results justifies revision of the current clinical guidelines. The results showed that it is not necessary to repeat the Pap test early on, with the exception of inadequate hemorrhagic and inflammatory cytological results.

Audit of cervical cancer screening and colposcopy attendance in rural South Africa

Women in developing countries generally lack access to cervical cancer preventive services. An audit was performed in rural South Africa to test the hypothesis that women do not follow (pre-)cancerous cervical disease treatment sufficiently, to understand the possible reasons for this non-attendance behavior, and to evaluate other published diagnostic and treatment initiatives. Based on Pap smear and colposcopy attendance data, including age, HIV status, month of attendance, and cervical intraepithelial neoplasia (CIN) staging, relatively few patients (54% of 928 patients) visited a colposcopy clinic following an abnormal Pap smear. Although these co-factors do not explain this high non-attendance rate, HIV status was an important co-factor; percentage-wise, HIV positivity correlated with a higher attendance rate. Screening methods that use mobile teams to successfully deliver cost-effective on-the-spot treatment warrant further attention.

[Satisfactory cervical cytology. Circular exocervical cytologic smears against longitudinal exocervical smears]

BACKGROUND

In the Mexican Institute of Social Security, since 1962 the exocervical sample is normally extended with a circular motion technique (the usual technique). In 2006, the Ministry of Health established that the exocervical sample shall be extended with longitudinal technique (standard technique). We proposed a new technique: the exocervical widespread. Our objective was to evaluate the efficacy and quality of three techniques.

METHODS

A quasi-experimental study in patients who applied for cervical cytology was performed. The variables analized were the exocervical extended technique, the cell coverage and the quality of exocervical sample. Groups were formed according to the exocervical extended technique. Cytology was processed with Papanicolaou technique and reported according to Bethesda System by three observers. Z-test, chi-squared test, Anova and relative risk were used as statistical methods.

RESULTS

The sample size was 213 smears, 71 per group. The inadequate cellular coverage was 2.75 times more frequent with the circular extended technique than with the one we proposed. The exocervical sample quality complies with circular technique; however, with the new tecnique increases 1.5 times (p < 0.05).

CONCLUSIONS

The proposed widespread technique allows greater possibilities of exocervical cell coverage, ensuring quality-cellularity and decreasing the amount of inadequate smears.

Attitude and practice of cervical cancer screening among the women of Bangladesh

Cervical cancer is the second most common cancer in women worldwide, but 80% of cancer occurs in developing countries. Bangladesh, like other developing countries faces a burden of diseases, in spite of having established screening program. This cross-sectional study was done to determine the knowledge, attitude and practice of cervical cancer screening among the women attending outpatient department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Two hundred women were enrolled in this study by purposive sampling. All the information was collected in a pre-designed structured questionnaire by an interviewer. Data were analyzed using statistical program SPSS version 17.0. About 12% of women had good knowledge regarding cervical cancer screening. Seventy eight percent of women did not ever have a screening test and 78.5% of women had no access to the facility of having a screening test. Seventy five percent of women had never been suggested by a doctor to have a screening test. The more the participants' age, low level of education and poor knowledge, the less the practice of cervical cancer screening (p<0.05). The most common reason cited for not having screening test was the lack of information. The women studied here demonstrated a very low coverage of the screening test and a poor knowledge regarding its utility. Improving the awareness is imperative for better implementation of cervical cancer screening program in Bangladesh.

Manual Liquid-Based Cytology: A Clinical Pilot Study of the VitroPrep™ Cytology Processing Kit

OBJECTIVE

It was the aim of this study to assess the utility of the manual liquid-based cytology (LBC) product VitroPrep™ Cytology Processing Kit (ChemQ Bioscience LLC, Research Triangle Park, N.C., USA).

STUDY DESIGN

This is a descriptive pilot study. Women underwent cervical sampling processed by the ThinPrep™ automated LBC system followed by cervical sampling for the VitroPrep manual system. The following criteria were assessed on a scale of 1-5 (1 = unsatisfactory, 2 = borderline, 3 = acceptable, 4 = good, 5 = excellent): monolayer cell adhesion, overall cellularity, background clarity, preservation of cellular morphology, red cell lysis, and elimination of mucus/debris. Cytological diagnosis was compared to results from ThinPrep samples. In addition, VitroPrep samples were taken prior to conization procedures and compared to pathology results. Descriptive statistics were performed.

RESULTS

Forty-two of 47 women who underwent dual cytologic sampling had satisfactory samples. All scores were 3-5, with >90% graded 4-5. The VitroPrep diagnosis correlated with the ThinPrep diagnosis in 90% (38/42) of cases. All specimens obtained from 15 women prior to conization were satisfactory and correlated abnormal cytologic findings with cervical intraepithelial neoplasia 1-3 pathology.

CONCLUSIONS

The VitroPrep Cytology Processing Kit was able to provide adequate specimens for evaluation and diagnosis. This low-cost processing kit may provide a useful alternative in settings where automated LBC systems may not be feasible.

Semi-automatic segmentation and classification of Pap smear cells

Cytologic screening has been widely used for detecting the cervical cancers. In this study, a semiautomatic PC-based cellular image analysis system was developed for segmenting nuclear and cytoplasmic contours and for computing morphometric and textual features to train support vector machine (SVM) classifiers to classify four different types of cells and to discriminate dysplastic from normal cells. A software program incorporating function, including image reviewing and standardized denomination of file names, was also designed to facilitate and standardize the workflow of cell analyses. Two experiments were conducted to verify the classification performance. The cross-validation results of the first experiment showed that average accuracies of 97.16% and 98.83%, respectively, for differentiating four different types of cells and in discriminating dysplastic from normal cells have been achieved using salient features (8 for four-cluster and 7 for two-cluster classifiers) selected with SVM recursive feature addition. In the second experiment, 70% (837) of the cell images were used for training and 30% (361) for testing, achieving an accuracy of 96.12% and 98.61% for four-cluster and two-cluster classifiers, respectively. The proposed system provides a feasible and effective tool in evaluating cytologic specimens.

Performance of a colposcopic examination, a loop electrosurgical procedure, and cryotherapy of the cervix

Colposcopy is the accepted diagnostic test for evaluation of an abnormal Pap test to determine the location and extent of cervical intraepithelial lesions (CIN). Loop electrocautery excision procedure (LEEP) is the preferred procedure for advanced diagnosis and treatment of CIN following colposcopy. Although LEEP is the preferred treatment of CIN, cryotherapy is an option for treatment in some settings due to it's ease of performance, minimal complications, and cost-effectiveness. This article focuses on the proper technique and use of these procedures to evaluate and treat cervical abnormalities.

Developing a hand-held Pap test card to improve cervical cancer screening

We identified an educational deficit among clients at a community health clinic regarding the latest cervical cancer screening recommendations. A literature search on Pap testing and problems with compliance or screening indicated multiple barriers to cervical cancer screening. Education, health promotion and the use of a hand-held health card/record were identified as methods to educate women regarding cervical cancer prevention. We developed a hand-held Pap test card to be similar to an immunization card. The card was designed to fulfill the needs of both clients and practitioners.

Uterine cervix conization based on Pap smear results: the "see and treat" approach

BACKGROUND

The "see and treat" approach, proceeding without a biopsy directly to uterine cervix conization in women diagnosed with high grade squamous intraepithelial lesion (HGSIL) on Pap smear, shortens the treatment duration, lessens patient anxiety, and reduces health care costs.

OBJECTIVES

To evaluate the level of diagnostic accuracy and the over-treatment rate in the "see and treat" versus conventional management of women diagnosed with HGSIL.

METHODS

We retrospectively reviewed all women with HGSIL who had undergone the "see and treat" approach during 2001-2011 at Soroka University Medical Center. Similar cohorts, who were managed conventionally with a cervical biopsy prior to the conization, served as a comparison group.

RESULTS

The study population consisted of 403 women: 72 (18%) had undergone the "see and treat" approach and 331 (82%) conventional management. The false positive rate was 11% for the "see and treat" group, compared to 6% for the conventional management group (P = 0.162). Similarly, no statistically significant difference was observed when comparing the positive predictive value (PPV) of high grade dysplasia diagnosed on Pap smear (PPV 88.9%) versus cervical biopsy (PPV 93.8%) (P = 0.204). Moreover, both the false positive rate and PPV remained similar in subgroups of patients, according to age, menopausal status, number of births, and colposcopy findings.

CONCLUSIONS

The accuracy level of HGSIL diagnosis on Pap smear is similar to that of high grade dysplasia on a cervical biopsy. We therefore recommend referring patients with HGSIL directly to conization. Skipping the biopsy step was not associated with significant over-treatment or other adverse effects.

Evaluation of CellSolutions BestPrep® automated thin-layer liquid-based cytology Papanicolaou slide preparation and BestCyte® cell sorter imaging system

OBJECTIVE

A double-blind study was conducted to compare the performance of the new BestPrep® (CellSolutions) liquid-based thin-layer Papanicolaou (Pap) test with ThinPrep® (Hologic).

STUDY DESIGN

Samples from the study patients (n = 105) were collected twice in the same encounter with the ThinPrep sample always taken first and the BestPrep sample collected second. Slides were prepared according to both manufacturers' protocols and evaluated using manual microscopic review and the BestCyte® cell sorter imaging system (CellSolutions). Diagnostic truth for each case was determined by independent manual review of both slides by multiple pathologists and histology when available. The presence of atypical squamous cells of undetermined significance was the threshold for positive for sensitivity and specificity calculations.

RESULTS

BestPrep and ThinPrep, by manual review, had sensitivities for high-grade squamous intraepithelial lesion (HSIL) cases of 100 and 95.6%, respectively. Using the BestCyte cell sorter, both had 100% sensitivity. For the same HSIL cases, the digene HC2 high-risk human papillomavirus DNA test had sensitivities of 100% (BestPrep) and 95.6% (ThinPrep). Specificities were 71.4% (BestPrep) and 54.8% (ThinPrep).

CONCLUSIONS

BestPrep was equivalent to ThinPrep for manual review even though BestPrep was always the second sample collected. The BestCyte cell sorter provides a practical alternative to manual review for both BestPrep and ThinPrep slides.

[Performance of health staff in Papanicolauo test: theoretical knowledge and practical implementation]

BACKGROUND

The quality of cervical cytology is one of the factors involved in the optimal performance of screening programs for cervical cancer in Mexico, so it is necessary to design indicators to improve the skills of health personnel in this procedure.

OBJECTIVE

To evaluate the performance of the health workers to take the Pap smear.

METHODOLOGY

cross-sectional study made in the period 2006-2007 in San Luis Potosí, Mexico, in 21 health centers in a health jurisdiction. We studied the universe of professionals who take the Pap: 100 nurses, doctors and interns. A knowledge test and a check list were applied. The correlation of Pearson, Student's t and ANOVA was used for data analysis.

RESULTS

There is a correlation between knowledge and qualification in the take of the Pap smear (r = 0.340) (p = 0.001). Providers have a performance on average 62.2% in knowledge and 78.5% in practice. Doctors obtained higher score in the knowledge that the nurses (6.80) (p = 0.000) and trainees (4.14) (p = 0.014). In the practical implementation, there was no difference between the doctors and the nurses (2.68) (p = 0.718) but there was difference between the doctors and interns (6.47) (p = 0.036). To know one or more sections of the knowledge influences the qualification of the procedure.

CONCLUSIONS

The performance of the service provider is regular. There is heterogeneity in the knowledge and practical skills. Educational interventions are needed to raise the skills.

Association of Trichomonas vaginalis and cytological abnormalities of the cervix in low risk women

Objective

Is Trichomonas vaginalis (TV) an inducing factor for the development of (pre-)cancerous lesions of the cervix?

Design

Cross sectional study.

Setting

Screening healthy Belgian women with low infection risk.

Sample

63,251 consecutive liquid based cervical samples.

Methods

Real time quantitative PCR for presence of TV, 18 HPV types and Pap smear analysis of cytologic abnormalities.

Main Outcome Measures

Association of TV and HPV with cervix dysplasia

Results

The overall prevalence of TV DNA was 0.37%, of low risk HPV 2%, of high risk HPV 13.2%, and 8.8 % had cytological abnormalities. Both LR-HPV and HR-HPV were significantly associated with all cytological abnormalities. Presence of TV was associated with LR- and HR-HPV, ASC-US and HSIL, but not with other abnormalities. All women with TV and HSIL also had HR-HPV, while the latter was present in only 59% of women with TV and ASC-US. Amongst HPV negative women, TV was found in 1.3% of women with ASC-US, but only in 0.03% of women with normal cytology (OR 4.2, CL95% 2.1-8.6). In HR-HPV positive women, presence of TV increased the likelihood of cytological abnormalities somewhat (P=0.05), mainly due to an increase in ASC-US and LSIL, but not HSIL.

Conclusions

We conclude that TV infection is associated with both LR and HR-HPV infection of the cervix, as well as with ASC-US and HSIL. TV is a concomitant STI, but is not thought to be a co-factor in the causation of HSIL and cervical cancer. However, TV may cause false positive diagnoses of ASC-US.

Pattern of cervical smear abnormalities using the revised Bethesda system in a tertiary care hospital in Western Saudi Arabia

OBJECTIVE

To evaluate Pap smear (PS) diagnoses at a tertiary care hospital using the revised Bethesda system, and to compare the results with other similar studies.

METHODS

We designed a retrospective study to review all PS from the Cytopathology Department of King Abdulaziz University Hospital, Jeddah, Saudi Arabia from January 2005 to December 2009.

RESULTS

Of the 7297 cases reviewed, 1254 cases (17.3%) had epithelial cell abnormalities. The categories included: atypical squamous cell of undetermined significance (ASC-US) found in 9.3%, atypical squamous cell, cannot exclude high squamous intraepithelial lesion (ASC-H) in 0.8%, low grade squamous intraepithelial lesion (LSIL) in 2.7%, and high grade squamous cell lesion (HSIL) in 0.9%. The mean age incidence (MAI) was 40 years for ASC-US, 42 years for ASC-H, 47 years for LSIL, and 45 years for MAI. Squamous cell carcinoma (SCC) was found in 0.06% with mean age incidence of 46 years. In the atypical glandular cell category, there was 3.2% atypical glandular cell of undetermined clinical significance not otherwise specified, 0.1% atypical glandular cells favoring neoplasm, and 0.08% atypical endometrial cells favoring neoplasm.

CONCLUSION

The incidence of abnormal PS has increased from previously 4.7%, to 17.3% in the present study. The ASC-US among total PS examined has also significantly increased. The increase in the number of positive PS raises concerns of whether the new BS results are an artificial increase in the prevalence and the predictive value of cytology to some extent.

In Papanicolaou smears, benign appearing endometrial cells bear no significance in predicting uterine endometrial adenocarcinomas

Reporting of benign appearing endometrial cells (BECs) in the Papanicolaou smears of women aging 40 years or older was mandated in the Bethesda System 2001 aiming at predicting the uterine pathology. The purpose of this study was to determine the clinical significance of the BECs in patients in our Medical Center. A two-arm study was designed in ≥40-years-old women with BECs and without BECs in their Pap smears from January 2002 to December 2004. Of 21,965 patients, 882 had BECs in their Pap smears and the rest did not. Among the patients with BECs, 186 (study group) and among those without BECs, 2,064 (control group) had histopathologic follow-ups. There were 4 patients in the study and 47 in the control groups who had uterine adenocarcinoma. The Chi-square P-value for adenocarcinoma between the two groups was 0.91; indicating insignificant differences between the two groups. We conclude that presence of BECs in the Pap smears of ≥40-years-old women signal no significance as a harbinger of endometrial adenocarcinoma.

Interwoven dendritic processes of follicular dendritic cell sarcoma demonstrated on ultrafast papanicolaou-stained smears: a case report

BACKGROUND

Follicular dendritic cell (FDC) tumor is a rare tumor derived from accessory cells in the lymphoid follicles. FDC tumors are typically diagnosed on histology based on immunoreactivity to at least 1 of the FDC markers (CD21, CD23 or CD35) or based on the characteristic ultrastructural feature of long, interwoven, cytoplasmic, dendritic processes connected by desmosomes.

CASE

We observed novel cytologic features of FDC sarcoma in a liver fine needle aspirate of a 46-year-old man status post surgery and chemotherapy for FDC sarcoma, originating in the gastrointestinal tract with metastases to the liver, pancreas and spleen. In the Diff-Quik- and Papanicolaou-stained smears, the tumor cells presented in syncytial fragments as well as single cells, as previously reported in the cytologic literature. However, the single cells were interconnected to neighboring single cells via long, thin, threadlike cytoplasmic processes in ultrafast Papanicolaou (UFP)-stained smears. The tumor cells possessed multipolar cytoplasmic processes rather than unipolar ones, as previously reported.

CONCLUSION

The ultrastructural features of a web of interwoven, dendritic, cytoplasmic processes of FDC tumor was demonstrated for the first time on cytology. Observation of this feature may allow the diagnosis to be made on cytology prior to histology, immunohistochemistry or electron microscopy.